Understanding EMU- Epilepsy Monitoring Unit
What is EEG?
An electroencephalogram (EEG) is a medical test that can detect electrical activity in your brain using electrodes applied to your scalp. This medical test is completely painless and can help diagnose several conditions, including epilepsy, sleep disorders and brain tumours.
Why is an EEG performed?
An EEG is used to evaluate changes in brain activity that may be useful in diagnosing brain disorders, particularly epilepsy - one of the most common neurological disorders that causes repeated seizures and affects people of all ages. The test can help your doctor find out the type of epilepsy you have, what may be triggering your seizures, as well as the best treatment options.
An EEG can also help in diagnosing or treating certain disorders such as - sleep disorders, Alzheimer’s disease or dementia, brain tumour, brain damage from head injury, encephalitis, stroke, etc. The test may also be used to confirm brain death in someone in a persistent coma. Doctors may also recommend an EEG for other reasons, including monitoring blood flow in the brain during a surgical procedure.
Types of EEG
There are many types of EEG, which have been described using different terms, such as:
1. Routine EEG: A routine EEG scan may take 20-30 minutes. During the procedure, an EEG technologist may ask the patient to rest quietly, open or close their eyes from time to time. Patients may also be asked to breathe differently or look at flashing lights.
2. Prolonged EEG: Prolonged EEG recording may take 1-2 hours, however, some types can take several days. A prolonged EEG can give the medical team more information than a routine EEG. This test may be used with or without video to diagnose or manage seizure disorders.
3. Sleep EEG: Also known as sleep-deprived EEG, this test is done while the patient is asleep. A sleep EEG may be used to test for sleep disorders if a routine EEG doesn’t give enough information.
4. Ambulatory EEG: An Ambulatory EEG, which usually lasts for about 1-3 days, can be done at home or at an EEG monitoring unit. During an ambulatory EEG, the electrodes will be connected to a small portable EEG recorder that can be clipped onto the patient’s clothing. Patients can continue with most of their daily normal activities while the machine records the electrical activity produced by the brain. However, patients must avoid getting the electrodes or recorder wet. Also, they should not scratch their head or chew gum while the test is running.
5.Video EEG: Video EEG, also called video telemetry or video EEG monitoring, is a more specialised form of an EEG test that films an epileptic patient continuously while an EEG records the brain activity. The video recording helps the doctors see and hear what they’re doing in the event of a seizure. Video EEG monitoring helps the doctor find out the cause of the seizures, the points of origin of the seizures, as well as choose the appropriate treatment option. This procedure may take over a few days and is usually done in a hospital setting where seizures can be monitored in a safe manner.
How to prepare for a video EEG
The patient must wash their hair the night before the test using only shampoo and water. They must avoid using any oil or hairspray as these products can interfere with the electrodes and limit the usefulness of the procedure.
The patient should eat normally and wear comfortable clothing.
The patient must check with the doctor about taking any regular medications. The doctor may reduce or stop any anti-seizure medication the patient takes to provoke seizure activity during the monitoring period.
What to expect from a video EEG
During the procedure
The electrodes will be attached to the patient’s scalp to record electrical activity in the brain. The examination is carried out in a room (epilepsy monitoring unit) having a wall-mounted camera that constantly records the patient’s activity. The patient may be asked to glare at a strobe light or hold their breaths for brief periods during the test. The patient can carry out normal activities, except in a few cases where patients may need some restraint in bed for their own safety, especially if anti-epileptic medication is withdrawn. The patient will not be able to shower or wash their hair while being monitored.
A specially-trained doctor will review the video EEG monitoring of the patient on a daily basis. The procedure is painless, and patients will not experience any discomfort.
After the procedure
The technician removes the electrodes with acetone, which dissolves the glue and leaves the skin and hair intact.
The patient may wash their hair if they wish, and return to the hospital room or go home as per the doctor’s instructions. Patients taking sedatives for the test may require rest until the medication has worn off.
Are there any side effects from a video EEG?
The EEG, including a video EEG, is considered a safe test with no side effects. Some patients may feel dizzy when they deep breath during the procedure. Some epileptic patients may also experience a seizure triggered by the various stimuli used in the test, including the flashing lights. However, patients will be closely monitored, and help will be on hand in case of such an eventuality. In fact, a seizure during an EEG can considerably help in diagnosis.
Results of video EEG
Once the test is completed and a full analysis of the data has been compiled, the doctor (an epileptologist) will schedule an appointment with the patient to go through the findings from the video EEG monitoring to diagnose and formulate a course of treatment. The video EEG results give the doctor significant information regarding the underlying cause of the seizures as well as the location of the abnormal electrical functioning in brain. However, results of video EEG may sometimes fail to provide a conclusive diagnosis, requiring additional testing that may involve MRI scans, PET scans or brain-imaging studies.
Video EEG in Children: What you need to know
A video EEG monitoring is used to record a child’s brain waves and a video of their behaviour. Basically, it aims to record a child’s EEG and behavioural during seizure episodes. This test does not hurt and is usually done in the epilepsy monitoring unit of the hospital. The duration of the test may vary from a few hours to a few days, depending on how often a child is having seizures.
Preparing a child for a video EEG:
Parents should explain the test to their child prior to the procedure.
They should shampoo the child’s hair the night before the test.
They should not use any oil, gel, hairspray, or hair extensions - also avoid pulling up or braiding long hair.
On the day of the test, the child can eat regular food, but should not have any drinks containing caffeine.
Parents must check with their child’s doctor about medications, because sometimes antiepileptic medication is reduced prior to or during the test to increase the chances of seizures. They should bring all the medications their child takes. They can also bring their child’s toys, games, books or other items that can help them stay calm and relax.
Parents should follow special instructions their given by their child’s doctor - such as waking the child up early or changing their sleep schedule on the day of the test.
The child should be made to wear comfortable clothing that buttons or zips down the front.
During the test:
One parent or guardian needs to stay with the child in the room during the procedure.
The child will be asked to lie down on a bed or stay in a chair.
The technician will part the hair to reach the child’s scalp for proper placement of electrodes that will be connected to EEG machine, after which the test will begin.
After the electrodes are in place, the child may move freely around the room, but will need to always stay in constant view of the camera, except while bathing and toileting for privacy.
The technician will provide a push button to the parent or guardian to press when seizures or events of concern occur.
One of the most important roles of a parent or guardian during the test is to help the child stay calm, relaxed and occupied. Toys, books, school work, or quiet games can be brought along to keep the child engaged.
The child may eat or do other activities in the room until the test is over.
After the test:
The electrodes will be removed from the child’s scalp using acetone to dissolve the glue.
After the test is finished, a nurse or technician will give the parents further instructions and tell them when they and their child can return home.
The child can eat, play and go to school as before.
A paediatric Epileptologist doctor will go through the video EEG test and send the results to the child’s doctor. Parents can collect the complete report of the video EEG from their child’s doctor about a week after going home.
At Fortis, we believe parents and guardians can play a vital role in the success of these tests.
EMU at Fortis Hospital, Mulund
Fortis Hospital, Mulund Department Neurosciences offers state-of-the-art diagnostic imaging and treatment options for all forms of epilepsy, including refractory epilepsy. The centre is only major comprehensive epilepsy centre in the eastern and central Mumbai focusing all touchpoints from awareness to recovery extending to surgery and psycho-social rehabilitation services for epilepsy.
Fortis Hospital, Mulund Neurosciences has a dedicated epilepsy monitoring units (EMU) for both children and adults - designed to evaluate, diagnose, and test patients with seizures. We have a dedicated team that includes epileptologist (Neurologists) and neurosurgeons, neuroradiologists, neuropsychologists, nurses, nutritionists, pharmacists, rehabilitation specialists and other professionals. They all work together in a multidisciplinary approach to offer individualised epilepsy care to adults and children.
The EMU team uses advanced technology such as electroencephalogram (EEG) monitoring with simultaneous videotaping (video EEG monitoring), magnetic resonance imaging, Positron Emission Topography (PET), deep brain stimulation (DBS), and other tests to accurately diagnose epilepsy. Fortis’ EEG technologists and nurses are specially trained to recognise and respond to seizures to maximize patients’ safety.
The Epilepsy Clinic at Fortis Hospital, Mulund, provides a comprehensive team approach to the diagnosis, medical and surgical treatment of epilepsy in children and adults. The clinic has unique experience treating patients with even the most complex seizure disorders. With state-of-the-art facilities, our experts are committed to providing excellent clinical management and applying advanced diagnostic and therapeutic techniques and approaches.Visit the Epilepsy Clinic every Friday 10 am to 1 pm.